Treating Depression

• What is the cognitive approach to treating depression?

  attempting to change negative schemas and challenging irrational thoughts through cognitive restructuring e.g. both Beck's CBT and Ellis' REBT treatments
• What is Beck's CBT treatment for depression?

  - cognitive behavioural therapy

  - a talking therapy that combines behavioural and cognitive approaches

  - challenges the negative triad

  - treating the patient as a scientist

  - the patient generates and tests hypotheses about the validity of their irrational thoughts in the hope that when they realise their thoughts don't match reality, this will change their schemas and the irrational thoughts can be discarded
• What does CBT involve?

  - thought catching - identifying irrational thoughts coming from the negative triad of schemas

  - homework tasks - includes keeping a diary, which is used to record negative thoughts and identify situations that cause negative thinking

  - behavioural activation - taking part in activities that the sufferer used to enjoy e.g. sports, travelling or socialising
• What is Ellis' REBT treatment for depression?

  - rational emotive behavioural therapy

  - a development of the ABC model, adding D (for dispute) and E (for effect)

  - dispute is the therapist confronting the client's irrational beliefs using empirical arguments (which challenge the client to provide evidence for their irrational beliefs) and logical arguments (which attempt to show that the beliefs do not make sense)

  - effect is the reduction of irrational thoughts (restructured Beliefs (B)), leading to better Consequences (C) in the future
• What does REBT involve?

  shame attacking exercises - the client performs a behaviour they fear doing in front of others. This shows the client they can act against their emotions and cope with an unpleasant experience, and they can survive other people's disapproval. This highlights how most people don't care or notice our actions, and ultimately we worry too much about others' approval
• What is the difference between CBT and REBT?

  while they do have the same end goal (the cognitive restructuring of irrational thoughts), in Beck's CBT therapy, the client is helped to figure out the irrationality of their thoughts themselves by acting as a scientist. In Ellis' REBT, the therapist explains the irrationality of the thoughts directly to the patient through disputation
• STRENGTH of the cognitive approach to treating depression: there is research support e.g March

  EVIDENCE - March (2007) randomly assigned 327 patients to one of three groups: CBT, drug therapy (the SSRI fluoxetine) and the third group was given a combined treatment of CBT and drug therapy

  EXP - after 36 weeks, CBT and drug therapy had an effectiveness rate of 81%. CBT also had a more significant reduction in suicidal events than drug treatment

  EVAL - however the best results came from the combination treatment, with an effectiveness rate of 86% and fewer suicidal events than either treatment alone
• STRENGTH of the cognitive approach to treating depression: explaining March's findings

  EVIDENCE - some people with depression are too severely depressed to engage with the demands of CBT

  EXP - for example, completing homework, challenging irrational thoughts and attending sessions require motivation and commitment

  EVAL - therefore, drug therapy may be required to stabilise a patient before psychological treatment
• STRENGTH of the cognitive approach to treating depression: the patients take an active role

  EVIDENCE - CBT assigns an active role to patients, giving them the responsibility to overcome their depression using tools provided by therapists. Advocates of CBT say this approach empowers patients and gives a sense of personal efficacy, enabling them to take control of their lives and make positive changes

  EXP - in contrast, drugs often require a passive role where patients are reliant in biological intervention and may feel helpless

  EVAL - critics of CBT argue that saying the client is responsible for the depression is victim blaming and suggesting depression is all in the mind and would go away if the client just thought differently. This leads to clients feeling shame and wider society thinking mental health conditions are less serious than other medical conditions
• WEAKNESS of the cognitive approach to treating depression: CBT and REBT overly focus on current problems

  EVIDENCE - both REBT and CBT may be overly focussed on the present and how to restructure how the client thinks about their current situation cognitively

  EXP - clients may want to discuss severe trauma in their past

  EVAL - also, reinterpreting present experiences does not necessarily improve the present situation, it may be that the client is in an unhealthy relationship, is experiencing unfulfilling work, discrimination or has financial problems - concerns about these social problems are not irrational
• WEAKNESS of the cognitive approach to treating depression: economically difficult for patients

  EVIDENCE - as CBT can take 16-20 sessions with a trained therapist, it is an expensive treatment option

  EXP - however, many patients prefer CBT to drugs due to the lack of side effects and a belief that CBT addresses the root cause of depression, not just reducing symptoms, as CBT is effective in the long term, with people able to return to work as productive workers and continue contributing to the economy

  EVAL - from a cost-benefit analysis, many feel CBT is worth the expense
• What are the behavioural/ cognitive elements of CBT?

  • behavioural - homework assignments are given between therapy sessions that test irrational beliefs against reality and putting new rational beliefs into practice
  • cognitive - identifying irrational negative thoughts through talking to client/ asking them to keep a diary. These thoughts are challenged through disputing e.g. empirical and logical disputing and replaced with more rational beliefs
• STRENGTH of the cognitive approach to treating depression: CBT is an effective therapy

  EVIDENCE - Ellis claimed a 90% success rate with treatment completed in an average of 27 sessions and Fava found that 25% of pps assigned to the 'drugs only' condition were symptom free after 2 years, but 75% of the 'drugs then CBT' condition were symptom free after 2y

  EXP - this shows that patients benefit from CBT and these benefits are long term

  EVAL - however, the therapy is not always effective at reducing the symptoms of depression, and this may be because clients don't always put their revised beliefs into action